Managed Care Pharmacist Jobs

About The Position

Requirements

• Doctor of Pharmacy (PharmD), or Bachelor of Pharmacy (RPh) with clinical experience, or completion of/current enrollment in a PGY1 residency in managed care pharmacy or pharmacy practice.
• Current and unrestricted State of Florida license.
• Strong computer skills, including Microsoft Office applications such as Outlook, Word, Excel, PowerPoint, and Access.
• Strong communication and presentation skills.

Nice To Haves

• Managed care experience is preferred but not required.
• Part D Coverage Determinations experience is preferred but not required.
• Part D Formulary Management experience is preferred but not required.
• HPMS Formulary Reference File (FRF) submission experience is preferred but not required.
• Programming or reporting software skills.

Responsibilities

• Manage formulary operations, including Formulary Reference File submissions in HPMS.
• Prepare drug monographs for new drug entity reviews.
• Develop educational materials for providers and provide internal professional staff education about the pharmacy benefit and formulary.
• Conduct member medication reviews to identify polypharmacy and inappropriate prescribing, and assist with medication reconciliation.
• Implement and oversee PBM rebate strategies.
• Participate in Pharmacy & Therapeutics Committee meetings, including reviewing and presenting new drug entities, new generics, and line extensions as needed.
• Review CMS model letters.
• Manage Part D Coverage Determinations and monitor cost-effective drug management.
• Perform medical necessity reviews for formulary exceptions and prior authorizations in accordance with Medicare Part D guidelines.
• Work with the PBM and formulary manager to manage formulary changes and update the Plan’s website with the latest CMS-approved formulary versions.
• Recommend cost-effective alternatives to providers and meet with prescribers one-on-one to communicate recommendations.
• Guide pharmacy technicians with clinical questions from prescribers, pharmacies, and members.
• Ensure clinical alignment of drug management across medical and pharmacy benefits, and identify opportunities for drug management, safety programs, and medical/pharmacy cost savings.
• Recommend utilization management edits, including prior authorization, step therapy, and quantity limits.
• Assist with developing and implementing Pharmacy Department policies and procedures.
• Oversee pharmacy-related member communications, including correspondence about coverage determination decisions.
• Review prescription utilization data to identify outliers, trends, and high-cost drug category drivers.
• Develop and implement prescription-drug cost-saving strategies and oversee progress on pharmacy cost-saving initiatives.
• Provide feedback to the Pharmacy Director and other key organizational stakeholders.
• Perform other projects, work, and activities as assigned by the Pharmacy Director.